Psychological Self-Help

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43
situation--including you--can and will change. Depressed people must
learn to think differently. 
We need to understand why some depressed people are such rigid
and poor thinkers. It is critical knowledge for working with suicidal
patients. The closed-mindedness of depressed people is amazing.
Yapko (1992) describes counseling a patient who recently had a heart
attack and a quadruple bypass. This man wouldn't talk or open his
eyes during the first hour of therapy; he quietly cried while his wife
told his story. When the patient finally talked in the second session, he
only said, "I'm going to die!" and sobbed. He could do nothing and
think of nothing but dying. In contrast, Viktor Frankl survived the
brutal conditions of a Nazi concentration camp, while many died, by
intensely desiring to live so he could be re-united with his wife. He had
a purpose and thought there was some chance if he could stay alive.
We must use our rational mind to find those rays of hope and to
develop realistic plans to make our future better. 
Self-critical withdrawal 
If we are sad, we respond more slowly and avoid ordinarily
pleasant (it may not be pleasant to the depressed person) and
unpleasant events. Indeed, there is evidence that depressed people
are especially sensitive to pain and even mildly irritating situations
(Carson & Adams, 1981). Perhaps because of this sensitivity, some
depressed persons have developed unique ways of reducing pain or
stress in addition to avoiding or withdrawing, namely, by making self-
critical or self-hurtful remarks (which may reduce criticism from others
or, in some masochistic way, reduce the stress). This sounds a lot like
the story of Sooty Sarah below. The outcome could be a miserable
recluse. 
We need to understand why some depressed people are such rigid
and poor thinkers. It is critical knowledge for working with suicidal
patients. Forest and Hokanson (1975) did an interesting study
supporting the notion that self-punishment could be rewarding, i.e. an
escape from conflict with someone else. In this study an aggressive
partner was permitted to shock depressed and non-depressed
subjects. Then those who were shocked were given the choice of
shocking their partner back, shocking themselves, or making a friendly
gesture to the partner. If the depressed subjects elected to shock
themselves, their autonomic responses (stress) declined more rapidly
than if they were aggressive or friendly. Non-depressives got relief
only by shocking the other person, not by self-punishment or being
friendly. For most of us, it seems astonishing that anyone would hurt
themselves more after being hurt by an aggressive SOB. Well, there
seems to be some relief--a payoff--for depressed persons if they
punish themselves instead of attacking the aggressor. Maybe sadness
is partly a self-punishment (and/or substitute for aggression). This
needs to be understood better and may also be involved in the next
odd-sounding theory. 
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